Facilitated Communication Fabricated

By Steven Novella, on February 19th, 2010

On my other blog, NeuroLogica, I have been following the case of Rom Houben – the 46 year old man in a coma for 23 years. His case was presented to the media by neurologist Steven Laureys as a patient who was more conscious than was apparent from his exam. As evidence for this the media was shown cogent communications from Houben – all done through facilitated communication.

The skeptical community expressed immediate doubts about this case, especially as in some videos Houben was apparently typing on a computer screen while looking away – a practical impossibility.

Recently I reported the fact that Dr. Laureys conducted follow up testing, and with proper controls it turns out the Houben’s communication through FC were all false – the facilitator, Linda Wouters, was doing all the communicating. What I did not know is that this follow up testing was the result of advice from Dr. Willem Betz and the Belgian Skeptics – who also conducted their own testing.

Way to go, Belgian Skeptics. Here is their report of the testing:

Facilitated communication with coma patient is fabricated

The ‘faciliated communication’ with Rom Houben, a Belgian man who allegedly was trapped in his body for 23 years, turns out to be fictional, new tests by the Belgian skeptical organization SKEPP have confirmed. Neurologist Dr. Steven Laureys and his team, who presented Houben’s case in the international press in November 2009, seem to have rushed to premature conclusions.

According to doctors, Rom Houben has been in a persistent vegetative state (PVS) for over 20 years. In November 2009, however, Dr. Laureys declared that three years ago his PET-scans had shown signs of consciousness in Mr Houben’s brain, and that now the patient was able to communicate. All over the world video footage showed the man fluently typing complex messages with one finger, with the help of a ‘facilitator’. This trained assistant guides his hand over a keyboard, trying to feel and amplify (facilitate) the patient’s minute intentional movements. In interviews Dr. Laureys claimed that his scans showed that up to 40% of patients, previously diagnosed as PVS, were trapped in a paralyzed body and could be “released”.

Many commentators expressed disbelief, and so did SKEPP, for several reasons, medical and others. The method of facilitated communication (FC) has since long been discredited. Controlled experiments have consistently demonstrated that none other than the facilitator is directing the ‘conversation’. In The Times and Der Spiegel, Dr. Laureys claimed that he had performed controlled experiments, which had convinced him of the reliability of FC. Later he expressed doubts and planned new tests, but by then the news of the miraculous rebirth after 23 years had already circulated the globe. How many new tests are needed and why wait months? Apart from some medical objections, one single observation should have been sufficient to discard the whole story: many of the videos show that the patient is typing with his eyes closed. Nobody can blind-type whole sentences with one finger. If you can, the €10.000 SKEPP-prize will be yours, and perhaps you can also apply for the $ 1.000.000 Randi prize.

At the request of the medical institution where Mr Houben is cared for, on February 4 2010 SKEPP was present as advisor for a planned test of this controversial method of communication, and we also conducted our own tests. From the staff of the institute we learned that during two years all attempts to establish any form of communication with the patient by detecting and coding minute movements of the eyes or any other body part had failed. With FC he now seemed to produce correct words and elaborate sentences. Indeed, his answers to our simple test questions were intelligible and sometimes elaborate, but when the facilitator did not know the questions, his answers were all completely wrong. Most of the time he typed with his eyes closed, but as soon as the keyboard was shielded from the facilitator’s view the typing produced gibberish and halted. There clearly was no communication with the patient, only with the facilitator. We wonder what world-shaking news there would have been to communicate if it hadn’t been for the spectacular answers the facilitator produced.

Our intent was to not to test Mr Houben, but to test FC, and once more we demonstrated that the method is a sham. This is not to deny that Mr Houben may have some limited consciousness. If so, how frustrating must it be for him to hear all the bogus messages being produced in his name, without any possibility to protest ? After our test we had a long conversation with Dr. Laureys. He insisted that we test more facilitators before drawing conclusions. We declined and advised him to clearly distance himself from the FC scam, which he has done today. Out of respect and to allow them time to discuss the results with the family and the dedicated staff, we agreed on a 2 weeks embargo before making the results of our test public. Of course, not everyone is convinced yet. In a phone conversation today Mr Houben’s mother told us that she still believes in FC, because “sometimes it had produced answers that only her son could have known”. She is convinced that Dr. Laureys will ultimately find a method to communicate with her son. His team is experimenting with other methods. Let’s hope her wish comes true.

The international news coverage of this case has given many relatives of coma patients false hope, and the advocates of the illusionary facilitated communication got an undeserved publicity boost. The emotional impact on patients’ families can’t be underestimated. The decision to present this case before the international media was premature, to say the least.